S0515 Combination Chemotherapy, Rituximab, and Bevacizumab in Treating Older Patients With Stage II, Stage III, or Stage IV Diffuse Large B-Cell Lymphoma

DISEASE CHARACTERISTICS:

• Histologically confirmed* diffuse large B-cell lymphoma, meeting 1 of the following stage criteria:

  • Bulky stage II
  • Stage III
  • Stage IV NOTE: *Adequate sections from the original diagnostic specimen must be available; needle aspiration or cytology are not considered adequate
• Bidimensionally measurable disease
• CD20-positive disease
• No prior indolent lymphoma, including histologic transformation or mixed histology with an indolent or nodular component
• No clinical evidence of CNS involvement by lymphoma

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• Zubrod 0-2

Life expectancy

• Not specified

Hematopoietic

• Absolute neutrophil count > 1,000/mm^3
• Platelet count > 100,000/mm^3
• No bleeding diathesis or coagulopathy

Hepatic

• Not specified

Renal

• Creatinine < 2 times upper limit of normal
• No proteinuria ≥ +1 by dipstick or urinalysis OR
• Urine protein:creatinine ratio < 1.0 OR
• Urine protein < 1 g by 24-hour urine collection

Cardiovascular

• No uncontrolled hypertension
• No myocardial infarction within the past 6 months
• No unstable angina within the past 6 months
• No stroke within the past 6 months
• No arterial thrombosis within the past 6 months
• No clinically significant peripheral vascular disease
• Ejection fraction ≥ 45% by MUGA or 2-dimensional echocardiogram (2-D ECHO)
• No significant cardiac abnormality by MUGA or 2-D ECHO

Pulmonary

• No requirement for continuous supplemental oxygen

Gastrointestinal

• No abdominal fistula within the past 6 months
• No gastrointestinal perforation within the past 6 months
• No intra-abdominal abscess within the past 6 months

Other

• Not pregnant or nursing
• Fertile patients must use effective contraception during and for 6 months after completion of study therapy
• No known HIV positivity
• No history of hypersensitivity reaction to products containing polysorbate 20 (Tween 20), Chinese hamster ovary cell products, or recombinant human antibodies
• No traumatic injury within the past 28 days
• No serious or non-healing wound, ulcer, or bone fracture
• No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer, carcinoma in situ of the cervix, or adequately treated stage I or II cancer in complete remission

PRIOR CONCURRENT THERAPY:

Biologic therapy

• No prior antibody-based therapy for lymphoma

Chemotherapy

• No prior chemotherapy for lymphoma

Endocrine therapy

• Not specified

Radiotherapy

• No prior radiotherapy for lymphoma

Surgery

• More than 28 days since prior and no concurrent major surgery
• No prior solid organ transplantation

Other

• Concurrent full-dose anticoagulants allowed for treatment of venous thrombosis provided the following criteria are met:

  • INR in range (i.e., 2-3)
  • Patient is on a stable dose of warfarin or low molecular weight heparin
  • No bleeding or pathological condition that would confer a high risk of bleeding (e.g., tumor involving major vessels or known varices)